In this episode of Vital Conversations, Tim Coan sits down with Bill Duke, CFO of Connecticut Skin Health, to discuss the operational challenges of managing a multi-location dermatology practice. With 10 offices, over 100 employees, and more than 30 providers, Bill shares the complexities of staffing, onboarding, and maintaining consistent patient care across rural and urban locations. He emphasizes the critical role of thorough onboarding and the need for constant communication and coordination among staff to keep operations smooth. The conversation highlights the delicate balance between centralized systems and maintaining a local, familiar feel for patients, while tackling staffing shortages, retention struggles, and increasing demands for operational efficiency. The discussion also dives into the role of technology and data in synchronizing patient demand, provider capacity, and staffing - revealing that while tools and automation (especially around eligibility verification) have helped, human oversight remains essential. Bill reflects on the financial implications of operational optimization, explaining that consolidating information and streamlining processes across locations significantly improves a practice’s financial health. The episode wraps up with insights on the importance of treating multi-location management as an interconnected system rather than isolated units, showcasing how even small improvements in efficiency can lead to major gains.